A study at the Hamad General Hospital in the State of Qatar on hearing loss in children (1) found a significant correlation between hearing loss (HL) and Rhesus blood groups. The study was intended to look at consanguinity (where the child's parents are related by blood or descended from a common ancestor) and other parental factors, and consanguinity was also found to have an association with HL, as well as high blood pressure in the father and illiteracy or family history of HL of either parent.

The finding in this study that if the mother's Rhesus blood group was Rh positive the child had a higher risk of HL is not the first connection to be found between blood groups and HL, as a previous study found blood group O to be at highest risk of noise-induced HL.

Further research combining the effects of these two common blood group factors could be useful in screening for and preventing HL in individuals at higher risk.

The idea of the 'Polypill' was first mooted in 2003 by Professors Nick Wald and Malcolm Law of London’s Wolfson Institute of Preventive Medicine (1), suggesting that if everyone over age 55 and anyone with existing cardiovascular disease took a single pill per day without screening, ischaemic heart disease events would be reduced by 88% and stroke by 80%. Side effects would be “minimal” (only 15% of those taking the pill).

The polypill proposed by Wald and Law would have six ingredients: a statin, aspirin, folic acid, and three antihypertensives (a thiazide, a ß blocker, and an angiotensin converting enzyme inhibitor), all at half dose. The combination, the authors said, would prevent heart disease and stroke by reducing four different risk factors—blood pressure, lipid concentration, homocysteine concentration, and platelet function. Financial considerations reduce the cost-benefit ratio: if the Polypill included the three classes of blood pressure lowering drugs with the lowest prevalence of adverse effects (thiazide, angiotensin II receptor antagonist, and calcium channel blocker) instead of the three with the cheapest ingredients (thiazide, ß blocker and ACE inhibitor) only 8% of those taking the pill would suffer adverse symptoms.

At a recent meeting of experts organised by the US Centers for Disease Control in Atlanta it was suggested that three powerful groups are threatened by the Polypill idea: the drug industry, doctors, and the public health lobby, which “generally favours lifestyle change over mass drug treatment”. The drug industry and doctors obviously stand to lose income and clientele from removing individualised diagnosis, treatment and prescription, as the Polypill will no longer need consultations and can use generic components that are not subject to patent protection. The public health lobby however could lose the option of personalised healthcare, and the right to take control of their own health and prevent disease through the natural self-healing ability of the body when using appropriate diet and natural medicine according to individual need without any side effects.

The fact that while statins can perform the dubious task of lowering cholesterol levels in healthy individuals, it can also cause cardiomyopathy by depletion of coenzyme Q-10, is one of the ironies of both statins and the Polypill concept, apart from the rarer side-effects of rhabdomolysis, memory loss and hepatitis, however statins are now available over the counter in the UK without prescription, with no inclusion of or recommendation to take co Q-10. Beta-blockers are well known for their mind-numbing effects as well as their unsuitability for those with asthma. Hypokalaemia (potassium deficiency) may occur with thiazide diuretics. ACE inhibitors can cause acute renal failure, more common in the older population. Aspirin is unsuitable for those with salicylate intolerance, and causes internal bleeding, particularly in individuals of blood group O, however the authors say that the risk of increase in haemorrhagic stroke (from bleeding) would be exceeded by the reduction in thrombotic strokes (from a blood clot), giving the all-important cost-benefit ratio. The authors failed to mention natural medicines that prevent strokes from bleeding without any side-effects. The authors say about a third of people taking the Polypill would ‘benefit’ overall (at the expense of half of this number of people having side-effects).

The only useful thing about this concept is that it raises the profile of the significance of homocysteinaemia in cardiovascular disease. [The role of folic acid for reduction of homocysteine is well documented, however research suggests that synthetic folate supplementation (pteroyl-L-monoglutamic acid, a product of the pharmaceutical industry which rarely occurs in nature) could cause an increase in the incidence of breast cancer (2). The authors of this paper would wish that it be considered as nothing more than a 'research pointer', as the number of deaths in the study was small (31 actual deaths), and the findings were balanced with commentary and several notes of caution, although the article has already caused front page headline reactions in the tabloid press. Although we are told in the research that the "tablets were supplied in six colours, two of which contained folate in 0.2 mg and 5 mg daily doses”, what is not reported is which colouring agents were used, and whether carcinogenic azo dyes had an influence on the results].

Interestingly a version of the polypill is likely to appear on the market in India by the end of 2005, as the authors stated “widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention”. Is it that resistance would be less from the three major groups who could influence the acceptability of the Polypill idea would have less influence in India? The recipients of the pill are unlikely to be monitored for side-effects due to the fact that “the tests lack specificity, so the increased risk of cardiovascular disease after stopping the drug in people positive on monitoring may outweigh any benefit” – the cost-benefit ratio again.

Based on the potential costs and adverse effects of the Polypill, the concept of the Polymeal was raised in 2004 (3) with the objective of identifying “an effective, non-pharmacological, safe, cheap, and tasty alternative to reduce cardiovascular morbidity and increase life expectancy in the general population”. The ironic tone of this article suggests that an “evidence based recipe” includes wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds. Using similar analysis to that of the Polypill study, the authors state that “combining all the ingredients of the Polymeal resulted in cardiovascular disease being reduced by 76%. Whether increasing the amount of each ingredient would increase the effect of the Polymeal is uncertain”.

The article was published just before Christmas and makes amusing reading: if the Polypill ingredients were used to fortify flour used in Polymeals, “redundant cardiologists could be retrained as Polymeal chefs and wine advisers”. There are however some serious conclusions: “Pharmacological interventions are not the only option for preventing heart disease; a healthy diet and an active lifestyle reduce cardiovascular disease as well”. It is unfortunate that the idea of a healthy diet is not taken seriously by the medical community at large, and the article had to be presented as a joke.

The concept behind the Polymeal article could also be applied to the idea of the Polypill: “The preventive strategy outlined here is radical. But the ‘healthy person’ is an outdated concept from the era before scientific prevention. We should recognise that in Western society we all have cardiovascular risk factors, so everyone is at risk, and the diseases they cause are common and often fatal.”

What the authors of both Poly- studies fail to appreciate (or admit) is that some individuals are at greater risk of heart disease than others, and the cost-benefit ratio of many foods are different according to some easily-measured factors, not least ABO blood group and salivary secretor status. If individuals were given access to the information about simple food choices on a large scale they could take control of their own health.

Researchers writing in the journal Lancet (1) report that drinking is unlikely to be good for you. The popular notion that one or two units of alcohol a day can be protective from heart disease had been well supported by observational data, although there had been no clinical trials to confirm the theory [but then, so was the equally popular notion that hormone replacement therapy protected women from heart disease—until proper clinical trials showed that observational data cannot always be trusted]. It now seems likely that complete tee-totallers are simply too different from people who drink in moderation to be able to quantify the impact of alcohol on heart disease.

In a study in the American Journal of Preventive Medicine (2) 27 out of 30 cardiovascular risk factors were more common among abstainers than moderate drinkers. The study was carried out in the U.S. by telephone survey, and found that non-drinkers were more likely to have characteristics associated with increased cardiovascular disease mortality in terms of demographic factors, social factors, behavioural factors, access to health care, and health-related conditions. This makes moderate drinkers look good, even though their lower cardiovascular risk is nothing to do with the occasional glass of wine.

The study concludes: "Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States." If anything, heavy drinking is more likely to be protective of heart disease than light drinking, say the researchers. Unfortunately, there's little point in cleaning out your coronary arteries with a cellular poison that will simply kill you in some other way.

It would appear that moderate drinkers live longer in spite of their occasional glass of wine, not because of it. Season's Greetings.

Starting off as a big baby may not be so good for you when you grow up: a new study (1) has found that the largest babies, or those who grow fastest are more likely to become overweight adults. The British Medical Journal carried out a review of the association between infant growth during the first two years of life and obesity in adulthood, and all studies were found to be consistent. Prevention of obesity may therefore need to start very early.

--

Main Course:

Diet and Alzheimer's Disease

Another recent dietary study (2) links a 'high fat' diet with the amyloid-beta (Abeta) deposits that cause Alzheimer's disease (AD) in the brains of mice. Previous studies have linked the consumption of cholesterol and saturated fats with Abeta deposition. The difference with this new study is the low carbohydrate content of the diet that the mice were given.

The principle that dietary fat might play a relatively passive role in metabolism and that the distribution of fat is regulated by the hormonal state stimulated by carbohydrate is standard basic biochemistry knowledge, but remains an under-appreciated factor in many studies, possibly due to the emphasis on low-fat recommendations of nutritional agencies. Because of the requirement of brain cells for glucose (or ketones) for energy metabolism and, in particular, because of the involvement of insulin in regulating a proteolytic enzyme in Abeta production, it is relevant to inquire about the role of macronutrient composition in the diet in AD. In doing so, the medical research world seems to be gradually getting closer to the fact that many people eating according to their blood group have known for a long time: sometimes dietary carbohydrate restriction can be part of a collection of factors that reduce inflammation. What doesn't seem to be appreciated in most diet studies is how other research shows that individuals of blood groups A and B are more prone to Alzheimer's disease than O and AB due to a different reason: a higher stress response to cortisol (3).

The authors of the study conclude: "a diet rich in saturated fats and low in carbohydrates can actually reduce levels of Abeta. Therefore, dietary strategies aimed at reducing Abeta levels should take into account interactions of dietary components and the metabolic outcomes, in particular, levels of carbohydrates, total calories, and presence of ketone bodies should be considered." The description 'high fat diet' is thus an inadequate way to characterize a diet: one must also specify the level of carbohydrate.

Looking for a reason for this, the article postulates: "evidence suggests that the primary genetic risk factor for late onset AD, the epsilon4 allele of apolipoprotein E, may have been selected against in populations with long historical exposure to agriculture." Individuals with this genotype are more prone to AD. The gene that did better with exposure to agriculture was the blood group A gene, which expressed in people who survived on a lower fat diet. Reduced levels of intestinal alkaline phosphatase in individuals of blood group A and AB means that they cannot digest fat well in their diet, but they may be able to better tolerate complex carbohydrate. Conversely individuals of blood group O and B may be able to tolerate more dietary fat, and less carbohydrate - the diet which gave less Abeta deposition in the study (on mice).

The study also says: "foods rich in carbohydrates are relatively recent additions to the human diet and are likely to be more evolutionarily discordant than high fat diets. Therefore, the recent evolutionary switch to high carbohydrate diets may play an important role in development of AD". In terms of blood groups, this is more likely to be true with individuals of blood groups O and B, but those with blood groups A and AB may not benefit from the high fat levels seen in this study.

Perhaps we should get away from the principle that “you are what you eat,” and replace it with the idea that “you are what you do with what you eat.”

--

Dessert:

Reduce That Sweet Tooth With Weight Loss

Losing weight sensibly can reduce sugar cravings: In a recently published study (4) ten women were tested to see how quickly they found repeated eating or drinking of a sweet substance to be unpalatable after fasting overnight. They were then put on a weight loss diet (composed of 50% carbohydrate, 25% protein and 25% fat). After 3 months they had all lost weight, most had reduced their BMI by over 5%, but also all felt satiated earlier and withdrew from ingesting the sweet substance more quickly than before they started dieting.

The authors conclude: "Maintaining a lowered set-point, by consuming a sensible diet that promotes satiety and gradual weight loss, may be the key for long-term success, as the body strives to maintain a body weight close to that set-point by reducing food intake and enhancing energy expenditure."

This study shows that a standard calorie-controlled weight loss programme will eventually reduce the amount of sweets that the dieter craves before feeling satiated.

--

References:

(1) Baird J, Fisher D, Lucas P, et. al:

Being big or growing fast: systematic review of size and growth in infancy and later obesity

The second conference of the Institute for Human Individuality The Four Masters: Nutrigenomics in Practice heralded the start of a new era in medicine. It took place in Tempe, Arizona, between April 15-17, and this year the event lasted two and a half days, packed with new information for clinicians and the public alike.

On arrival delegates were fingerprinted, and asked to put two pieces of paper in their mouth to assess a bitter taste, but were not told why. The reason for this became apparent later.

Dr. Bland - FUNCTIONAL MEDICINE/NUTRIGENOMICS

The first master to speak after the opening ceremonies on Friday Morning was the widely venerated Dr. Jeffrey Bland PhD. Dr. Bland is author of the book Genetic Nutritioneering, - a Functional Approach (which contains a chapter on blood groups), and also wrote the preface for 'Live Right for Your Type'. He set a lively pace to the start of the conference, introducing the connection between genetics and inflammatory conditions, pharmacogenomics and the "trilogy of omics": functional genomics, proteomics and metabolomics.

The latest definition of nutrigenomics includes: "The study of how different foods may interact with specific genes to modify the risk of common chronic diseases... seeks to identify the bioactive molecules in the diet that affect health by altering the expression of genes... the influence of diet on health is related to an individual's genetic makeup."

Genetics is closely linked with evolution, and Dr. Bland expounded the two different theories relating to evolution: natural selection and adaptation. He said that if human evolution happened by natural selection, it took hundreds of millions of years. The subsequent transition from the 'average' human less than a hundred years ago to the typically unwell obese junk-food eating subfertile American could not have happened by the same method, but by the modulation of gene and protein expression and function that controls our phenotype (how we look and feel) by food and the presence of absence of nutrients. This situation is unsustainable, and according to Dr. Bland it is based on a false set of assumptions which are eventually guaranteed to bankrupt the medical healthcare system while opening the door for the development of 'personalised medicine' through the diet/chronic disease connection. Numerous scientific references demonstrated how the revolution in nutrigenomics is taking medicine away from "Taylorism", or standardisation of the client, towards an age of investigation and respect for individuality. The implication throughout was that nutrigenomics is not a fad, but is here to stay. Dr Bland’s message is to encourage people to "exercise their central nervous systems" to find out what is behind the media manipulation, and ''get on the bus or be left behind at the bus stop".

The ability of folate to modify gene expression was discussed extensively during the lecture. Using folate in preconceptual care can be extended beyond the traditional role in prevention of neural tube defects according to recent research: maternal folate supplementation decreases incidence of childhood acute lymphoblastic leukaemia in offspring; coronary heart disease may be considered a long latency disease, beginning in utero; nutritional reduction of breast cancer risk may be folate-dependent; the effects of lowering homocysteine relies on folate; a specific post-methotrexate folate rescue protocol helps counteract the side-effects of methotrexate; epilepsy is sometimes related to folate.

The aetiology of Parkinson's disease, including genetic factors, environmental factors, and the interaction between them is modifiable at many levels: oxidative stress; mitochondrial dysfunction; excitotoxicity; inflammation; Dr. Bland explained how all these may respond to appropriate specific nutritional intervention.

Nutrigenomic intervention to balance immunity may be targeted at either division of the immune system, TH1, the innate (primitive, or cellular), or TH2, the acquired (adaptive, or humoral) division. Individual differences in secretory IgA and glycosylated polypeptides (ABO blood group) influence the genetic uniqueness of the GALT system (Gut-Associated Lymphatic Tissue) and enteric colon bacteria. ABO secretor status is significant in childhood asthma, allergy and atopy (TH2-dominant disorders), susceptibility to systemic inflammation (TH1-dominant). Conditions such as COPD (chronic obstructive pulmonary disease) and arterial disease depend on the the neuroendocrine immune system functioning as a whole, which is tightly controlled by genetic uniqueness (as in a polymorphism of the COX-2 gene, for example). There was much more information that Dr. Bland did not have time to present...

Dr. D'Adamo - POLYMORPHISMS

In his first lecture Dr. D'Adamo encouraged people to move away from the idea that blood type medicine is a perfect unchangeable monolithic structure. Rather it is a working system; the innovations in nutrigenomics presented at this conference along with further discoveries relating to ABO blood group and other polymorphisms can all be incorporated into the concept of treating patients as individuals.

The lecture gave an overview of the ABO blood group system and the influence of salivary secretor status: Dr. D'Adamo reviewed how gene linkage with an individual's blood group decides activity of both dopamine beta-hydroxylase (an enzyme affecting monoamine oxidase activity, which governs metabolism of noradrenaline and serotonin) and arginine succinate synthase (affecting nitric oxide synthesis, having many effects throughout the body), as they all overlap on the same gene location (at 9q34). Clinical tools such as the connection with blood group B and BUN (urea) blood values, and the haemaglutinin titer were introduced.

On Friday evening North American Pharmacal hosted a poolside reception with a blood group compatible buffet, live music suitable for all blood groups, and a chance for conference attendees to mingle.

Martha D'Adamo - MOO PAL DAN KHUM

Saturday and Sunday mornings started at 7am with meditation and breathing. Martha D'Adamo, a black belt in karate, took early risers through the Moo Pal Dan Khum exercise sequence. This is a qi gong-style series of ancient breathing exercises designed to help tone and move energy through the body.

Dr. Pizzorno - THE SALUGENETICIST

Dr. Joseph Pizzorno, originally a student of Dr. Bland, and subsequently a tutor of Drs. D'Adamo and Crinnion, presented a more detailed analysis of the crisis in healthcare. The US system has spiraling costs, and yet ranked 72nd in health of the population in a survey of 191 countries in 2002. Like Dr. Bland, Dr. Pizzorno also suggested that the solution is to move away from symptomatic treatment, whether conventional of using 'green drugs', to a new personalised curative medicine promoting health, disease resistance and reversal. An example was given of a post-menopausal woman with progressive bone loss and low sunlight exposure due to family history of skin cancers, who was unresponsive to standard natural interventions. She was found to have a polymorphic deficit in vitamin D receptors, and increasing her dosage of calcium and vitamin D to above the normal range stabilised her bone density.

Evaluation of all variables in a situation such as migraine needs assessment of 27 possible physiological dysfunctions, 25 possible environmental/drug toxins, 40 possible natural medicine therapies and evaluation of 900 research citations. This is too much for any physician to keep in their head. The increasing amount of possible causes and interventions for any given situation lead Dr. Pizzorno to investigate the use of artificial intelligence (AI) tools in natural medicine. The result is a tool using a Bayesian inference system called the Salugenicist (meaning health promotion, as opposed to pathogenesis). As one would expect from the author of so many naturopathic textbooks, the report generated by his software contains recommendations for dietary, nutritional, lifestyle and exercise, herbal adjustments and even healthy recipes based on the patient's individualised analysis.

Although fully functioning and demonstrated live at the conference, the program was estimated to be about a quarter of what will be in the final version. Impressive drill down options allowed exploration of every answer, including abstracts of referenced articles. The system is rapidly expanding, but does not yet contain blood type specific information or secretor status (one of the first questions asked by the audience). The program is designed to reduce the time spent by the doctor looking into his computer screen and give more quality time with the patient, with fewer adverse reactions of interactions and improved efficacy of intervention. With the advent of AI, natural medicine is truly coming of age. Further details can be seen at www.salugenecist.com<br />Dr. D'Adamo - DERMATOGLYPHICS, BIOMETRICS AND SYMMETRIES

Dr. D'Adamo's second lecture introduced this surprise topic. The scientific study of fingerprints has entered the repertoire of naturopathic practitioners using genetic markers: the shape of the epidermal ridge patterns are determined between four weeks and 5 months in utero. These patterns may represent developmental pathways underlying multi-organ syndromes. Further, the height of the fingerprint ridges are a sign of gut glycosylation; ridge atrophy gives an indication of the health of the gut mucosa, and many other associations - finger length, angle of palmar creases. Also under genetic control is the ability to taste phenylthiocarbamide, which has an association with thyroid overactivity, and ear wax type, which correlates with breast cancer. The audience duly assessed their own susceptibility to disease by inspecting their fingerprint cards received at the start of the conference, relieved that it was not a plot by the Institute for Human Individuality to register people following subversive alternative medical approaches.

Dr. Crinnion - BORN IN THE WRONG CENTURY: POLYMORPHISMS AND THE TOXIC ENVIRONMENT

As a specialist in environmental medicine, Dr. crinnion started his lecture by reviewing phase I and II detoxification systems and cytochrome P450. He then developed the subject of toxicogenomics with reference to the connection between toxin exposure and cancer risk. A survey carried out specifically for the lecture showed higher self-reporting of caffeine and drug sensitivity in ABO non-secretors than in secretors. Environmental illness may also be the result of polymorphisms, and testing is now widely available.

Always the naturopath at heart, Dr. Crinnion made reference to the 12 most pesticide-contaminated foods, encouraging people to buy organic. He concluded "Genetics points the gun, but the environment pulls the trigger".

Dr. Debra Wollner - IfHI RESEARCH UPDATE

There are currently three projects at the Southwest College of Naturopathic Medicine (SWCNM) relating to nutrigenomics. Dr. Wollner gave details of a study on the "Effect of Specific Lectins on Microbial-Epithelial Adhesion". The thinking behind this is that lectins may be able to alter the association between bacteria and red blood cells. Dr. Jami Kupperman, a SWCNM graduate and research fellow, described a pilot study on how a low carbohydrate diet may interact with genetic variability, obesity and cardiovascular disease. This type of study could be the proof that individuals may do better or worse on a low carbohydrate diet depending on their blood group.

Saturday night included a Drumming up Health session with Christine Stevens, who created a community spirit through percussion. Delegates entered a trance-like state during the session, and danced while beating their drums.

Dr. D'Adamo - USING THE SWAMI SOFTWARE

Dr. D’Adamo introduced his new software package SWAMI: ‘Serotyping With Amplification, Modification, Interpretation’ (although the choice of acronym is also "a lighthearted way of poking fun at all swamis and crystal ball gazers"). The presentation pulled together all the various aspects of the whole seminar. A freeware PC application based on MS Access, SWAMI asks for blood group and secretor status, biometric (such as head size) and dermatoglyphic (fingerprint) data and family history. Two ‘reaktors’ give a numerical value for lectin sensitivity and glycosylation index. The next version, ‘SWAMI pro’, will be available soon, and will contain a Diet Generator module that generates and prints out a clinically detailed and individualised diet for each patient, a Therapy Generator that designs supplement and treatment protocols specifically for that patient, and the ability to input lab tests and other non-biometric, yet clinically significant parameters (such as Traditional Chinese Medicine diagnostics). Further information can be found at: www.dadamo.com/SWAMI<br />In summary, Dr. D’Adamo said that the Blood Type Diet (BTD) is now evolving into the Human Individuality Program (HIP). Overall the conference added significantly to assisting the clinical understanding of genetic and biometric uniqueness of patients, which can be put into current practice alongside blood type medicine.